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Predictive factors of clinical response in steroid-refractory ulcerative colitis treated with granulocyte-monocyte apheresis

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World Journal of Gastroenterology 2011年第14期17卷 1831-1835页

作者： Valeria D'Ovidio Donatella Meo Angelo Viscido giampaolo bresci Piero Vernia Renzo Caprilli Department of Clinical Sciences Gastrointestinal UnitPoliclinico Umberto IUniversity of Rome"La Sapienza"Viale del Policlinico 155Rome 00161Italy Gastrointestinal Unit Azienda Ospedaliera-Universitaria PisanaPisa 56100Italy

AIM:To identify factors predicting the clinical response of ulcerative colitis patients to granulocyte-monocyte apheresis (GMA). METHODS:Sixty-nine ulcerative colitis patients (39 F,30 M) dependent upon/refractory to steroids were treated with GMA. Steroid dependency,clinical activity index (CAI),C reactive protein (CRP) level,erythrocyte sedimentation rate (ESR),values at baseline,use of immunosuppressant,duration of disease,and age and extent of disease were considered for statistical analysis as predictive factors of clinical response. Univariate and multivariate logistic regression models were used. RESULTS:In the univariate analysis,CAI (P = 0.039) and ESR (P = 0.017) levels at baseline were singled out as predictive of clinical remission. In the multivariate analysis steroid dependency [Odds ratio (OR) = 0.390,95% Confidence interval (CI):0.176-0.865,Wald 5.361,P = 0.0160] and low CAI levels at baseline (4 < CAI <7) (OR = 0.770,95% CI:0.425-1.394,Wald 3.747,P = 0.028) proved to be effective as factors predicting clinical response. CONCLUSION:GMA may be a valid therapeutic option for steroid-dependent ulcerative colitis patients with mild-moderate disease and its clinical efficacy seems to persist for 12 mo.

关键词：溃疡性结肠炎临床反应单核细胞粒细胞预测治疗 logistic回归模型激素

Clinical impact of selective transarterial chemoembolization on hepatocellular carcinoma:A cohort study

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World Journal of Gastroenterology 2009年第15期15卷 1843-1848页

作者： Rodolfo Sacco Marco Bertini Pasquale Petruzzi Michele Bertoni Irene Bargellini giampaolo bresci Graziana Federici Luigi Gambardella Salvatore Metrangolo Giuseppe Parisi Antonio Romano Antonio Scaramuzzino Emanuele Tumino Alessandro Silvestri Emanuele Altomare Claudio Vignali Alfonso Capria Gastroenterology Department Pisa University Hospital Institute of Interna Medicine University of Foggia Department of Diagnostic and Interventional Radiology Pisa University Hospital

AIM:To prospectively evaluate the short and long term clinical impact of selective transarterial chemoembolization (TACE) on liver function in patients with hepatocellular carcinoma (HCC).To assess side effects in relation to treatments.To analyze the overall survival and HCC progression free survival probability. METHODS:One hundred and seventeen cirrhotic patients with HCC were enrolled.Baseline liver function included Child-Pugh score and serum levels of alanineaminotransferase (ALT),prothrombin time(PT)and bilirubin.According to Cancer Liver Italian Program (CLIP) and Barcelona Clinic Liver Cancer (BCLC) staging systems,71 patients were eligible for TACE; 32 had previously received treatment for HCC.No significant differences in liver function were observed between previously treated and not treated patients. TACE was performed by selective catheterization of the arteries nourishing the lesions.While hospitalized, patient sunder went clinical,hematologicand ultrasonographic assessments.One month after TACE a CT scan was performed to assess tumor response. A second TACE was performed"on demand".Liver function tests were checked in all patients every four months.RESULTS:After first TACE,the mean Child-Pugh score increased from a mean baseline 5.62±1.12 to 6.11±1.57 at discharge time (P<0.0001),decreasing after four months to 5.81±0.73 (not significant).ALT,PT and bilirubin significantly (P<0.0001)increased 24 h after TACE and progressively decreased until discharge. After the second TACE,variations in Child-Pugh score,ALT,PT and bilirubin were comparable to that described after the first TACE.No major complications were observed.The mean follow-up was 14.7±6.3 mo (median:16 mo).Only one patient died.No other patient experienced important long term worsening of clinical status.The overall survival probability at twenty-four months was 98.18%with a correspondent HCC progression free survival probability of 69%. CONCLUSION:Selectiv TAC Emayproduce significant,but transitory increases in ALT values, with no major i

关键词：肝动脉化疗栓塞术肝癌患者临床表现队列研究血清丙氨酸转氨酶肝动脉栓塞化疗肝功能试验肝硬化患者

Pulmonary or otolaryngologic extraesophageal manifestations in patients with gastroesophageal reflux disease

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World Journal of Gastrointestinal Endoscopy 2010年第2期2卷 47-49页

作者： giampaolo bresci Rodolfo Sacco Gastroenterology Department Cisanello Pisa University Hospital Pisa 56124 Italy Institute of Internal Medicine University of Foggia Viale Pinto Foggia 71100 Italy

The extraesophageal manifestations of gastroesophageal reflux disease that are similar to a heart attack or gastric diseases are well known, while those categorized as pulmonary or otolaryngological are less known and... 详细信息

关键词： Gastroesophageal reflux Extraesophageal symptoms Gastroesophageal reflux disease

Beneficial and detrimental effects of natural dietary products on the risk of hepatocellular carcinoma, and their roles in its management

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Hepatoma Research 2016年第1期2卷 53-61页

作者： Rodolfo Sacco Caterina Conte Sara Marceglia Valeria Mismas giampaolo bresci Antonio Romano Roberto Eggenhoffner Luca Giacomelli Department of Gastroenterology Cisanello University Hospital56127 PisaItaly Endocrinology and Metabolic Disease UniversitàCattolica del Sacro Cuore00168 RomeItaly Department of Engineering University of Trieste34100 TriesteItaly Department of Surgical Sciences and Integrated Diagnostics School of MedicineUniversity of Genoa16163 GenoaItaly

Hepatocellular carcinoma(HCC)is a common solid malignancy and a leading cause of cancer-related death worldwide.The mechanisms underlying the pathogenesis and development of HCC are complex and heterogeneous.Although mainly related to hepatitis B and C chronic infection;HCC may also arise from diet-associated conditions such as non-alcoholic fatty liver disease and non-alcoholic steatohepatitis.Furthermore,toxins and nutrients such as mycotoxins and alcohol have an established role in the pathogenesis of chronic liver diseases,whereas specific diet patterns or foods have been associated with a reduction in HCC risk.The aim of this review is to provide a thorough overview of the clinically relevant effects-either beneficial or detrimental-of natural products consumed by humans on HCC risk and management.

关键词： Hepatocellular carcinoma natural products diet dietary supplements

Assessment of clinical and radiological response to sorafenib in hepatocellular carcinoma patients

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World Journal of Hepatology 2015年第1期7卷 33-39页

作者： Rodolfo Sacco Valeria Mismas Antonio Romano Marco Bertini Michele Bertoni Graziana Federici Salvatore Metrangolo Giuseppe Parisi Emanuele Tumino giampaolo bresci Luca Giacomelli Sara Marceglia Irene Bargellini Dipartimento di Gastroenterologia-UO Gastroenterologia e Malattie del Ricambio Azienda Ospedaliero Universitaria Pisana56124 PisaItaly Dipartimento di Elettronica Informazione e BioingegneriaPolitecnico di Milano20100 MilanItaly Dipartimento di Radiologia-Azienda Ospedaliero Universitaria Pisana 56124 PisaItaly

Sorafenib is an effective anti-angiogenic treatment forhepatocellular carcinoma(HCC). The assessment of tumor progression in patients treated with sorafenib is crucial to help identify potentially-resistant patients,avoiding unnecessary toxicities. Traditional methods to assess tumor progression are based on variations in tumor size and provide unreliable results in patients treated with sorafenib. New methods to assess tumor progression such as the modified Response Evaluation Criteria in Solid Tumors or European Association for the Study of Liver criteria are based on imaging to measure the vascularization and tumor volume(viable or necrotic). These however fail especially when the tumor response results in irregular development of necrotic tissue. Newer assessment techniques focus on the evaluation of tumor volume,density or perfusion. Perfusion computed tomography and Dynamic ContrastEnhanced-UltraS ound can measure the vascularization of HCC lesions and help predict tumor response to antiangiogenic therapies. Mean Transit Time is a possible predictive biomarker to measure tumor response. Volumetric techniques are reliable,reproducible and time-efficient and can help measure minimal changes in viable tumor or necrotic tissue,allowing the prompt identification of non-responders. Volume ratio may be a reproducible biomarker for tumor response. Larger trials are needed to confirm the use of these techniques in the prediction of response to sorafenib.

关键词： Hepatocellular carcinoma Sorafenib ResponseEvaluation Criteria in Solid Tumors Perfusioncomputed tomography Dynamic Contrast-Enhanced-UltraSound Volumetric assessment

Transarterial radioembolization for hepatocellular carcinoma:An update and perspectives

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World Journal of Gastroenterology 2015年第21期21卷 6518-6525页

作者： Rodolfo Sacco Valeria Mismas Sara Marceglia Antonio Romano Luca Giacomelli Marco Bertini Graziana Federici Salvatore Metrangolo Giuseppe Parisi Emanuele Tumino giampaolo bresci Ambra Corti Manuel Tredici Michele Piccinno Luigi Giorgi Carlo Bartolozzi Irene Bargellini Department of Gastroenterology Pisa University Hospital Department of Electronics Information technology and BioengineeringEngineering School of Milan Department of Nuclear Medicine Pisa University Hospital Division of Health Physics Pisa University Hospital Department of Radiology Pisa University Hospital

In the last decade trans-arterial radioembolization has given promising results in the treatment of patients with intermediate or advanced stage hepatocellular carcinoma(HCC),both in terms of disease control and tolerability profile.This technique consists of the selective intra-arterial administration of microspheres loaded with a radioactive compound(usually Yttrium90),and exerts its therapeutic effect through the radiation carried by these microspheres.A careful and meticulous selection of patients is crucial before performing the radioembolization to correctly perform the procedure and reduce the incidence of complications.Radioembolization is a technically complex and expensive technique,which has only recently entered clinical practice and is supported by scant results from phase Ⅲ clinical trials.Nevertheless,it may represent a valid alternative to transarterial chemoembolization(TACE) in the treatment of intermediate-stage HCC patients,as shown by a comparative retrospective assessment that reported a longer time to progression,but not of overall survival,and a more favorable safety profile for radioembolization.In addition,this treatment has reported a higher percentage of tumor shrinkage,if compared to TACE,for pre-transplant downsizing and it represents a promising therapeutic option in patients with large extent of disease and insufficient residual liver volume who are not immediately eligible for surgery.Radioembolization might also be a suitable companion to sorafenib in advanced HCC or it can be used as a potential alternative to this treatment in patients who are not responding or do not tolerate sorafenib.

关键词： Hepatocellular carcinoma Radioembolization Transarterial chemoembolization Sorafenib Staging RECIST, Modified RECIST Downsizing Clinical trial

Treatment of active steroid-refractory inflammatory bowel diseases with granulocytapheresis: Our experience with a prospective study

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World Journal of Gastroenterology 2006年第14期12卷 2201-2204页

作者： bresci giampaolo Parisi Giuseppe Bertoni Michele Mazzoni Alessandro Scatena Fabrizio Capria Alfonso U.O. di Gastroenterologia U.O. di Immunoematologia Azienda Ospedaliera-Universitaria Pisana PisaItaly

瞄准：与活跃的类固醇倔强的煽动性的肠疾病(IBD ) 在 14 个病人与 granulocytapheresis (GCAP ) 的使用报导我们的经验以便在完成宽恕并且维持一个长持续没有症状的时期评估它的功效。方法：疾病的活动被临床的活动索引(蔡) 和内视镜... 详细信息

瞄准：与活跃的类固醇倔强的煽动性的肠疾病(IBD ) 在 14 个病人与 granulocytapheresis (GCAP ) 的使用报导我们的经验以便在完成宽恕并且维持一个长持续没有症状的时期评估它的功效。方法：疾病的活动被临床的活动索引(蔡) 和内视镜的索引(EI ) 在 ulcerative (UC ) 评估，当时由 Crohn 在 Crohn 的疾病(CD ) 的疾病活动索引(CDAI ) 。病人用 Adacolumn 系统被对待，有选择地绑在 granulocytes 和单核白血球的吸附列。GCAP 的一个会议 / 星期为 5 wk 被执行。类固醇在词首字母的脱落期间被停止。结果：所有病人完成了不显示出复杂并发症的五星期的功课。在最后会议的结束， 93% 病人显示出为 6 瞬间坚持了的疾病的临床的宽恕。在治疗的结束以后的九个月， 60% 案例维持了宽恕，当 23% 病人仍然在在 12 瞬间以后的临床的宽恕时。结论：就算我们有类固醇倔强的 IBD 的病人的数字不大，我们能断言 GCAP 很好被容忍并且有效特别在在治疗以后的开始的六个月内，在盒子的一个重要百分比。持续反应的率在 12 瞬间以后在 6 瞬间以后并且显著地稍微落下，然而，严重副作用的缺席能是为进一步评估治疗的新时间表的刺激。

关键词：类固醇耐火材料肠炎溃疡

Clinical epidemiology of chronic viral hepatitis B:A Tuscany real-world large-scale cohort study

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World Journal of Hepatology 2018年第5期10卷 409-416页

作者： Cristina Stasi Caterina Silvestri Roberto Berni Maurizia Rossana Brunetto Anna Linda Zignego Cristina Orsini Stefano Milani Liana Ricciardi Andrea De Luca Pierluigi Blanc Cesira Nencioni Donatella Aquilini Alessandro Bartoloni giampaolo bresci Santino Marchi Franco Filipponi Piero Colombatto Paolo Forte Andrea Galli Sauro Luchi Silvia Chigiotti Alessandro Nerli giampaolo Corti Rodolfo Sacco Paola Carrai Angelo Ricchiuti Massimo Giusti Paolo Almi Andrea Cozzi Silvia Carloppi Giacomo Laffi Fabio Voller Francesco Cipriani Observatory of Epidemiology Regional Health Agency of TuscanyFlorence 50141Italy Center for Systemic Manifestations of Hepatitis Viruses(MaSVE) Internal Medicine and Liver UnitDepartment of Experimental and Clinical MedicineCareggi University HospitalFlorence 50134Italy Web Solutions Data Visualization and Scientific DocumentationRegional Health Agency of TuscanyFlorence 50141Italy Hepatology Unit Department of Clinical and Experimental MedicineUniversity Hospital of PisaPisa 56100Italy Gastroenterology Research Unit Department of Experimental and Clinical Biomedical Sciences“Mario Serio”Careggi University HospitalFlorence 50134Italy Infectious Disease Unit Hospital of LuccaLucca 55100Italy Infectious Diseases Unit Department of Medical BiotechnologiesSiena University HospitalSiena 53100Italy Infectious Disease Unit “S.Maria Annunziata”HospitalPonte a Niccheri 50012Italy Infectious Disease Unit Hospital of GrossetoGrosseto 58100Italy Infectious Disease Unit Hospital of PratoPrato 59100Italy Infectious and Tropical Diseases Unit Department of Experimental and Clinical MedicineCareggi University HospitalFlorence 50134Italy Gastroenterology and Metabolic Disorders Department of SurgeryCisanello University HospitalPisa 56100Italy Gastroenterology Unit Department of Translational Research and New Technologies in Medicine and SurgeryCisanello University Hospital of PisaPisa 56100Italy Liver Surgery and Transplantation Unit Department of Surgical PathologyMedicineMolecular and Critical AreaCisanello University HospitalPisa 56100Italy Internal Medicine Unit “San Jacopo”HospitalPistoia 51100Italy Infectious Diseases and Hepatology Unit Department of Internal and Specialized MedicineUniversity Hospital of SienaSiena 53100Italy Gastroenterology Unit San Giuseppe HospitalEmpoli 50053Italy Internal Medicine and Liver Unit Department of Experimental and Clinical MedicineCareggi University HospitalFlorence 50135Italy Department of Prevention Central Tuscany Local UnitFlorence 5

AIM To build a regional database of chronic patients to define the clinical epidemiology of hepatitis B virus(HBV)-infected patients in the Tuscan public health care system.METHODS This study used a cross-sectional cohort design. We evaluated chronic viral hepatitis patients with HBV referred to the outpatient services of 16 hospital units. Information in the case report forms included main demographic data, blood chemistry data, viral hepatitis markers, instrumental evaluations, and eligibility for treatment or ongoing therapy and liver transplantation. RESULTS Of 4015 chronic viral hepatitis patients, 1096(27.3%) were HBV infected. The case report form was correctly completed for only 833 patients(64% males, 36% females; mean age 50.1 ± 15.4). Of these HBV-infected patients, 73% were Caucasian, 21% Asian, 4% Central African, 1% North African and 1% American. Stratifying patients by age and nationality, we found that 21.7% of HBV-infected patients were aged < 34 years(only 2.8% were Italian). The most represented routes of transmission were nosocomial/dental procedures(23%), mother-to-child(17%) and sexual transmission(12%). The most represented HBV genotypes were D(72%) and A(14%). Of the patients, 24.7% of patients were HBe Ag positive, and 75.3% were HBe Ag negative. Of the HBV patients 7% were anti-HDV positive. In the whole cohort, 26.9% were cirrhotic(35.8% aged < 45 years), and 47% were eligible for or currently undergoing treatment, of whom 41.9 % were cirrhotic. CONCLUSION Only 27.3% of chronic viral hepatitis patients were HBV infected. Our results provide evidence of HBV infection in people aged < 34 years, especially in the foreign population not protected by vaccination. In our cohort of patients, liver cirrhosis was also found in young adults.

关键词： Hepatitis B virus infection Liver fibrosis Cirrhosis Public health Epidemiology

A Double Assessment of Privacy Risks Aboard Top‑Selling Cars

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Automotive Innovation 2023年第2期6卷 146-163页

作者： giampaolo Bella Pietro Biondi Giuseppe Tudisco Dipartimento di Matematica e Informatica Universitàdegli Studi di CataniaCataniaItaly Osservatorio Astrofisico di Catania Istituto Nazionale di AstrofisicaCataniaItaly

The advanced and personalised experience that modern cars offer makes them more and more data-hungry.For example,the cabin preferences of the possible drivers must be recorded and associated to some identity,while such data could be exploited to deduce sensitive information about the driver’s health.Therefore,drivers’privacy must be taken seriously,requiring a dedicated risk assessment framework,as presented in this paper through a double assessment combining the asset-oriented ISO approach with the threat-oriented STRIDE approach.The framework is tailored to the level of specific car brand and demonstrated on the ten top-selling brands as well as,due to its innovative character,Tesla.The two approaches yield different,but complementary findings,demonstrating the additional insights gained through their parallel adoption.

关键词： Automotive Cyber physical systems Risk management ISO 27005 STRIDE